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Saad A, Narr J, Frings A, Steinberg J, Katz T, Linke SJ. Surgical outcomes of laser in situ keratomileusis (LASIK) in patients with stable systemic disease. Int Ophthalmol 2024; 44:119. [PMID: 38418603 PMCID: PMC10902021 DOI: 10.1007/s10792-024-02956-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 12/04/2023] [Indexed: 03/01/2024]
Abstract
PURPOSE To evaluate the surgical outcome in terms of safety, efficacy, predictability, and retreatment rate of LASIK surgery in patients with controlled systemic diseases in comparison with healthy individuals. METHODS The retrospective study included data from 1936 eyes of 976 patients with stable systemic diseases who underwent LASIK surgery between January 2016 and June 2019. The safety, efficacy, predictability of the surgery, and retreatment rate were evaluated in comparison with a control group comprising 1951 patients. The study was approved by the local ethics committee and adhered to the principles of the Declaration of Helsinki. Statistical analysis was performed using R team and the level of statistical significance was set at p < 0.05. RESULTS All treatment groups demonstrated high safety and efficacy indices after LASIK surgery. Furthermore, the study arms demonstrated comparable predictability and retreatment rates to the control group in nearly all cases. Retreatment rates were significantly higher in the rheumatoid arthritis group (p = 0.03), while safety indices were significantly lower in the hay fever group compared to the control group (p = 0.004). No intra- or postoperative sight-threatening complications were documented. CONCLUSION Our findings suggest that selected patients with stable systemic conditions can safely undergo LASIK surgery and achieve comparable outcomes to healthy individuals. Further research is needed to better understand the treatment outcomes in this challenging patient population.
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Affiliation(s)
- Amr Saad
- Department of Ophthalmology, Heinrich-Heine University, Duesseldorf, Germany
| | - Jenny Narr
- Department of Ophthalmology, University Medical Center, Hamburg, Germany
| | - Andreas Frings
- Department of Ophthalmology, Heinrich-Heine University, Duesseldorf, Germany.
- Augenheilkunde & Augenlaser Zentrum PD Dr. med. A. Frings, Nuremberg, Germany.
| | - Johannes Steinberg
- Department of Ophthalmology, University Medical Center, Hamburg, Germany
- Zentrum Sehstärke, Hamburg, Germany
| | - Toam Katz
- Department of Ophthalmology, University Medical Center, Hamburg, Germany
- Care-Vision, Hamburg, Germany
| | - Stephan Johannes Linke
- Department of Ophthalmology, University Medical Center, Hamburg, Germany
- Zentrum Sehstärke, Hamburg, Germany
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Benabidi S, Frings A, Druchkiv V, Katz T. Influence of the patient's age on the safety, efficacy, and prediction accuracy of the microkeratome in laser-assisted in situ keratomileusis. Sci Rep 2024; 14:1972. [PMID: 38263379 PMCID: PMC10806251 DOI: 10.1038/s41598-023-50985-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 12/28/2023] [Indexed: 01/25/2024] Open
Abstract
The purpose of this retrospective pseudonymised data analysis was to determine whether the patient's age has an influence on the safety, efficacy, and prediction accuracy of laser in situ keratomileusis (LASIK) treatment of myopic and hyperopic eyes. This study was performed at CARE Vision GmbH (Düsseldorf, Germany) and included two patient cohorts: an older group with patients > 55 years old and a younger group with patients 30-40 years old. Each patient had a single LASIK treatment. The safety, efficacy, and prediction accuracy of the refractive results were analysed. In total, 682 patients were analysed, with 341 patients in each patient group (one eye per patient). There were 570 myopic eyes and 112 hyperopic eyes. In myopic eyes, the efficacy was significantly influenced by the patient's age but only in myopic eyes (myopic: p ≤ 0.05; hyperopic: p = 0.085), while safety was not significantly influenced by the patient's age in hyperopic or myopic eyes (p = 0.204). We found that LASIK treatment at an older age (> 55 years) resulted in almost the same safety outcomes as a LASIK treatment at a younger age (30-40 years) but with a lower efficacy; the efficacy correlated with the patient's age. If the patient was hyperopic, their age did not influence safety or efficacy.
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Affiliation(s)
- Safiya Benabidi
- Department of Ophthalmology, Medical Faculty and University Hospital Düsseldorf - Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Andreas Frings
- Department of Ophthalmology, Medical Faculty and University Hospital Düsseldorf - Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
| | - Vasyl Druchkiv
- Department of Ophthalmology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Clinica Baviera, Valencia, Spain
| | - Toam Katz
- Department of Ophthalmology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Care Vision Refractive Center, Hamburg, Germany
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Ćirković A, Katz T. Exploring the Potential of ChatGPT-4 in Predicting Refractive Surgery Categorizations: Comparative Study. JMIR Form Res 2023; 7:e51798. [PMID: 38153777 PMCID: PMC10784977 DOI: 10.2196/51798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/01/2023] [Accepted: 12/04/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND Refractive surgery research aims to optimally precategorize patients by their suitability for various types of surgery. Recent advances have led to the development of artificial intelligence-powered algorithms, including machine learning approaches, to assess risks and enhance workflow. Large language models (LLMs) like ChatGPT-4 (OpenAI LP) have emerged as potential general artificial intelligence tools that can assist across various disciplines, possibly including refractive surgery decision-making. However, their actual capabilities in precategorizing refractive surgery patients based on real-world parameters remain unexplored. OBJECTIVE This exploratory study aimed to validate ChatGPT-4's capabilities in precategorizing refractive surgery patients based on commonly used clinical parameters. The goal was to assess whether ChatGPT-4's performance when categorizing batch inputs is comparable to those made by a refractive surgeon. A simple binary set of categories (patient suitable for laser refractive surgery or not) as well as a more detailed set were compared. METHODS Data from 100 consecutive patients from a refractive clinic were anonymized and analyzed. Parameters included age, sex, manifest refraction, visual acuity, and various corneal measurements and indices from Scheimpflug imaging. This study compared ChatGPT-4's performance with a clinician's categorizations using Cohen κ coefficient, a chi-square test, a confusion matrix, accuracy, precision, recall, F1-score, and receiver operating characteristic area under the curve. RESULTS A statistically significant noncoincidental accordance was found between ChatGPT-4 and the clinician's categorizations with a Cohen κ coefficient of 0.399 for 6 categories (95% CI 0.256-0.537) and 0.610 for binary categorization (95% CI 0.372-0.792). The model showed temporal instability and response variability, however. The chi-square test on 6 categories indicated an association between the 2 raters' distributions (χ²5=94.7, P<.001). Here, the accuracy was 0.68, precision 0.75, recall 0.68, and F1-score 0.70. For 2 categories, the accuracy was 0.88, precision 0.88, recall 0.88, F1-score 0.88, and area under the curve 0.79. CONCLUSIONS This study revealed that ChatGPT-4 exhibits potential as a precategorization tool in refractive surgery, showing promising agreement with clinician categorizations. However, its main limitations include, among others, dependency on solely one human rater, small sample size, the instability and variability of ChatGPT's (OpenAI LP) output between iterations and nontransparency of the underlying models. The results encourage further exploration into the application of LLMs like ChatGPT-4 in health care, particularly in decision-making processes that require understanding vast clinical data. Future research should focus on defining the model's accuracy with prompt and vignette standardization, detecting confounding factors, and comparing to other versions of ChatGPT-4 and other LLMs to pave the way for larger-scale validation and real-world implementation.
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Affiliation(s)
| | - Toam Katz
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Skevas C, Thiwa D, Bartz-Schmidt KU, Katz T, Spitzer M, Dimopoulos S. Pupillotonia after endolaser retinopexy during vitrectomy for retinal detachment: a prospective cohort study comparing circumferential and focal retinopexy. Br J Ophthalmol 2023; 107:1900-1906. [PMID: 36288913 DOI: 10.1136/bjo-2022-321640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/30/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To determine differences in postoperative pupil diameter in eyes that undergo pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) with endolaser retinopexy (ELR), comparing 360° vs focal ELR. METHODS Patients with uncomplicated RRD who underwent PPV were prospectively analysed regarding the postoperative pupil diameter difference (PDD) between the affected eye and the partner eye. Group 1 underwent 360° ELR and group 2 received focal ELR. Postoperative vision and complications, including redetachment rate, macular oedema and epiretinal membrane formation, were also compared. RESULTS A total of 72 patients, 42 in group 1 and 30 in group 2, were analysed. PDD, as observed at 6 weeks, was significantly greater than the preoperative values in both groups 1 and 2. It increased by a mean of 1±1.11 mm in group 1 and by 0.5±0.78 in group 2. This initial increase in PDD receded over time, but remained statistically significant in both groups, even at 6 months. The top 20% of patients with the largest PDD change comprised 13 out of 15 eyes from group 1, which was a statistically significant overrepresentation (p=0.0435). CONCLUSIONS Moderate pupillotonia was induced post-ELR in vitrectomy and correlated to the extent of ELR. The pupillotonia effect of ELR was significantly less marked in pseudophakic eyes.
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Affiliation(s)
- Christos Skevas
- University Medical Center, Departrment of Ophthalmology, University of Hamburg, Hamburg, Germany
| | - David Thiwa
- University Medical Center, Departrment of Ophthalmology, University of Hamburg, Hamburg, Germany
| | - Karl-Ulrich Bartz-Schmidt
- Department of Ophthalmology, Eberhard Karls University Tübingen Faculty of Medicine, Tubingen, Germany
| | - Toam Katz
- University Medical Center, Departrment of Ophthalmology, University of Hamburg, Hamburg, Germany
| | - Martin Spitzer
- University Medical Center, Departrment of Ophthalmology, University of Hamburg, Hamburg, Germany
| | - Spyridon Dimopoulos
- Department of Ophthalmology, Eberhard Karls University Tübingen Faculty of Medicine, Tubingen, Germany
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Steinberg J, Mehlan J, Mudarisov B, Katz T, Frings A, Druchkiv V, J Linke S. Safety and Precision of Two Different Flap-morphologies Created During Low Energy Femtosecond Laser-assisted LASIK. J Ophthalmic Vis Res 2023; 18:3-14. [PMID: 36937201 PMCID: PMC10020788 DOI: 10.18502/jovr.v18i1.12720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 03/21/2022] [Indexed: 02/24/2023] Open
Abstract
Purpose Currently, two major principles exist to create LASIK flaps: firstly, a strictly horizontal (2D) cut similar to the microkeratome-cut and secondly an angled cut with a "step-like" edge (3D). The strictly horizontal (2D) cut method can be performed using apparatus such as the low-energy FEMTO LDV Z8 laser and its predecessors which are specific to this type. Alternatively, the low-energy FEMTO LDV Z8 laser's 3D flap design creates an interlocking flap-interface surface which potentially contributes toward flap stability. In addition, the FEMTO LDV Z8 offers flap-position adjustments after docking (before flap-creation). The current study analyzed precision, safety, efficacy, as well as patient self-reported pain and comfort levels after applying two different types of LASIK flap morphologies which were created with a low-energy, high-frequency femtosecond (fs) laser device. Methods A prospective, interventional, randomized, contralateral eye, single-center comparison study was conducted from November 2019 to March 2020 at the Hamburg vision clinic/ zentrumsehstärke, Hamburg, Germany. Eleven patients and 22 eyes received low-energy fs LASIK treatment for myopia or myopic astigmatism in both eyes. Before the treatment, the eyes were randomized (one eye was treated with the 2D, the other eye with the 3D method). Results The mean central flap thickness one month after surgery was 110.7 ± 1.6 μm (2D) and 111.2 ± 1.7 μm (3D); P = 0.365 (2D vs 3D). Flap thickness measured at 13 different points resulted in no statistically significant differences between any of the measurement points within/between both groups; demonstrating good planarity of the flap was achieved using both methods. Despite not being statistically significant, the surgeons recognized an increase in the presence of an opaque bubble layer in the 3D flap eyes during surgery and some patients reported higher, yet not statistically significant, pain scores in the 3D flap eyes during the first hours after the treatment. Overall, safety- and efficacy indices were 1.03 and 1.03, respectively. Conclusion In this prospective, randomized, contralateral eye study, the low-energy fs laser yielded predictable lamellar flap thicknesses and geometry at one-month follow-up. Based on these results, efficacy and safety of the corresponding laser application, that is, 2D vs 3D, are equivalent.
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Affiliation(s)
- Johannes Steinberg
- Department of Ophthalmology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Hamburg Vision Clinic, Hamburg, Germany
- CareVision GmbH, Hamburg, Germany
| | - Juliane Mehlan
- Department of Ophthalmology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Bulat Mudarisov
- Department of Ophthalmology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Toam Katz
- Department of Ophthalmology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- CareVision GmbH, Hamburg, Germany
| | - Andreas Frings
- Univ.-Augenklinik Düsseldorf, Düsseldorf, Germany
- Augenarztpraxis PD Dr. Frings, Nürnberg, Germany
| | - Vasyl Druchkiv
- Department of Ophthalmology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Hamburg Vision Clinic, Hamburg, Germany
| | - Stephan J Linke
- Department of Ophthalmology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Hamburg Vision Clinic, Hamburg, Germany
- CareVision GmbH, Hamburg, Germany
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Saad A, Frings A, Druchkiv V, Katz T. Pre- and postoperative angle kappa in MIOL patients after touch-up LASIK. PLoS One 2023; 18:e0283578. [PMID: 37023053 PMCID: PMC10079129 DOI: 10.1371/journal.pone.0283578] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/23/2023] [Indexed: 04/07/2023] Open
Abstract
PURPOSE To study the influence of angle kappa (κ) on visual acuity after implantation of a multifocal intraocular lens (MIOL) and consecutive "touch-up" corneal refractive surgery with Laser-in-situ-Keratomileusis (LASIK). METHODS This retrospective multicenter study included patients who underwent MIOL surgery and consecutive LASIK (= Bioptics) in the period from 2016 to 2020 at Care Vision Refractive Centers in Germany. Our study was approved by the local ethics committee at the University in Duesseldorf (approval date: 23.04.2021) and conducted according to the tenets of the Declaration of Helsinki and Good Clinical Practices Guidelines. The pre- and post-operative κ of 548 eyes were measured using a Scheimpflug-based imaging system. Corrected distance visual acuity (CDVA) and the safety index (SI) were analyzed in relation with κ. For a more detailed analysis, the cohort was divided into pre-operative hyperopic and myopic patients to show group-specific differences. RESULTS There was a significant decrease (p<0.001) in the magnitude of κ after MIOL implantation and Bioptics. However, there was almost no significant correlation of κ on CDVA and SI, pre- and postoperatively. CONCLUSION A large κ is not a significant risk factor for poor visual acuity. Therefore, it is not a suitable clinical predictor of postoperative outcomes after a Bioptic procedure.
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Affiliation(s)
- Amr Saad
- Department of Ophthalmology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Andreas Frings
- Department of Ophthalmology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Vasyl Druchkiv
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Clinica Baviera, Valencia, Spain
| | - Toam Katz
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Care-Vision, Martinistraße, Hamburg, Germany
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Skevas C, Levering M, Engelberts J, Grinsven MV, Katz T. Simultaneous screening and classification of diabetic retinopathy and age-related macular degeneration based on fundus photos—a prospective analysis of the RetCAD system. Int J Ophthalmol 2022; 15:1985-1993. [DOI: 10.18240/ijo.2022.12.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 09/19/2022] [Indexed: 11/24/2022] Open
Abstract
AIM: To assess the accuracy of an artificial intelligence (AI) based software (RetCAD, Thirona, The Netherlands) to identify and grade age-related macular degeneration (AMD) and diabetic retinopathy (DR) simultaneously based on fundus photos.
METHODS: This prospective study included 1245 eyes of 630 patients attending an ophthalmology day-care clinic. Fundus photos were acquired and parallel graded by the RetCAD AI software and by an expert reference examiner for image quality, and staging of AMD and DR. Adjudication was provided by a second expert examiner in case of disagreement between the AI software and the reference examiner. Statistical analysis was performed on eye-level and on patient-level, by summarizing the individual image level-gradings into and eye-level or patient-level score, respectively. The performance of the RetCAD system was measured using receiver operating characteristics (ROC) analysis and sensitivity and specificity for both AMD and DR were reported.
RESULTS: The RetCAD achieved an area under the ROC (Az) of 0.926 with a sensitivity of 84.6% at a specificity of 84.0% for image quality. On image level, the RetCAD software achieved Az values of 0.964 and 0.961 with sensitivity/specificity pairs of 98.2%/79.1% and 83.9%/93.3% for AMD and DR, respectively. On patient level, the RetCAD software achieved Az values of 0.960 and 0.948 with sensitivity/specificity pairs of 97.3%/73.3% and 80.0%/90.1% for AMD and DR, respectively. After adjudication by the second expert examiner sensitivity/specificity increases on patient-level to 98.6%/78.3% and 100.0%/92.3% for AMD and DR, respectively.
CONCLUSION: The RetCAD offers very good sensitivity and specificity compared to manual grading by experts and is in line with that obtained by similar automated grading systems. The RetCAD AI software enables simultaneous grading of both AMD and DR based on the same fundus photos. Its sensitivity may be adjusted according to the desired acceptable sensitivity and specificity. Its simplicity cloud base integration allows cost-effective screening where routine expert evaluation may be limited.
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Nöthel J, Katz T, Druchkiv V, Frings A. Effect of Postoperative Ocular Residual Astigmatism (ORA) on Treatment Outcome After Myopic Laser in situ Keratomileusis (LASIK). Clin Ophthalmol 2022; 16:2079-2092. [PMID: 35770247 PMCID: PMC9236448 DOI: 10.2147/opth.s352410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/08/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Johanna Nöthel
- Department of Ophthalmology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- Correspondence: Johanna Nöthel, Email
| | - Toam Katz
- Department of Ophthalmology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Vasyl Druchkiv
- Department of Research & Development, Clínica Baviera, Valencia, Spain
| | - Andreas Frings
- Department of Ophthalmology, Heinrich-Heine-University Duesseldorf, Duesseldorf, North Rhine-Westphalia, Germany
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Schindler P, Mautone L, Druchkiv V, Katz T, Spitzer MS, Skevas C. Predicting speed of progression of lens opacification after pars plana vitrectomy with silicone oil. PLoS One 2022; 17:e0268377. [PMID: 35594273 PMCID: PMC9122216 DOI: 10.1371/journal.pone.0268377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/27/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose An increasing number of posterior segment disorders is routinely managed with pars plana vitrectomy (PPV). In older, phakic patients cataract formation is expected within the first two years after surgery. For younger patients its progression is individually fluctuating. This study uses an objective quantitative measurement for lens-status-monitoring after PPV with silicone oil to derive predictions for progression and severity of post-operative lens opacification evaluated in patients with rhegmatogenous retinal detachment (RRD). Methods Data acquisition was performed prospectively between March 2018 and March 2021. PentacamHR® Nucleus Staging mode (PNS) was used to objectively gather data about nuclear cataracts after PPV at different time points. Data was grouped into training and test sets for a mathematical prediction model. Via backward variable selection method a mathematical formula was set up by means of which predictions about lens densitometry (LD) can be calculated. Results 20 males [58.8%] and 14 females [41.2%] matched the inclusion criteria (mean age 50.6 years [23–75; ±12.3]). Average follow-up was 8.1 months (3,4–17.4; ±3.4). Mean baseline LD of the treated and fellow eye before surgery was 11.1% (7.7%-17.6%; ±2.0) and 11.2% (7.7%-14.8%; ±1.5), respectively. Predicted LD values by the model for five pre-selected patients closely match the observed data with an average deviation of 1.06%. Conclusions Using an objective parameter like LD delivered by the PentacamHR® PNS mode additionally to the patient’s age allows us to make an individual prediction for any time after PPV with silicone oil due to RRD for all ages. The accuracy of the model was stronger influenced by baseline LD as cofactor in the equation than patient’s age. The application for the prediction lens opacification [which can be accessed for free under the following link (https://statisticarium.com/apps/sample-apps/LensDensityOil/)] can help vitreoretinal surgeons for patient consultation on the possibility to combine PPV with cataract surgery.
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Affiliation(s)
- Philipp Schindler
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Luca Mautone
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Vasyl Druchkiv
- Department of Research & Development, Clínica Baviera, Valencia, Spain
| | - Toam Katz
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Stephan Spitzer
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christos Skevas
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Skevas C, Bigdon E, Steinhorst A, Katz T, Schindler P, Kromer R, Spitzer MS. A novel temporary keratoprosthesis technique for vitreoretinal surgery. Int J Ophthalmol 2021; 14:1791-1795. [PMID: 34804872 DOI: 10.18240/ijo.2021.11.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/01/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the safety of vitreoretinal surgery when using a soft contact lens as a temporary keratoprosthesis (TKP) in patients with severe corneal opacifications. METHODS Three patients with simultaneous corneal and vitreoretinal pathology were treated with a soft contact lens that was used as a TKP to facilitate vitreoretinal surgery. The soft contact lens was fixated with sutures onto the globe so that no leakage was possible. RESULTS Vitreoretinal surgery with excellent fundus view was possible in all cases. The soft contact lens allowed safe central and peripheral vitrectomy. Surgery was successful in all cases. CONCLUSION A soft contact lens properly fixated on the globe can successfully replace a TKP. This surgical procedure has several advantages like one size fits all, low costs, and easy access to the material.
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Affiliation(s)
- Christos Skevas
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Eileen Bigdon
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Alexander Steinhorst
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Toam Katz
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Philipp Schindler
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Robert Kromer
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Martin Stephan Spitzer
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
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Dulz S, Dimopoulos V, Katz T, Kromer R, Bigdon E, Spitzer MS, Skevas C. Reliability of the ocular trauma score for the predictability of traumatic and post-traumatic retinal detachment after open globe injury. Int J Ophthalmol 2021; 14:1589-1594. [PMID: 34667737 DOI: 10.18240/ijo.2021.10.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/30/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To elucidate the question of whether the ocular trauma score (OTS) and the zones of injury could be used as a predictive model of traumatic and post traumatic retinal detachment (RD) in patients with open globe injury (OGI). METHODS A retrospective observational chart analysis of OGI patients was performed. The collected variables consisted of age, date, gender, time of injury, time until repair, mechanism of injury, zone of injury, injury associated vitreous hemorrhage, trauma associated RD, post traumatic RD, aphakia at injury, periocular trauma and OTS in cases of OGI. RESULTS Totally 102 patients with traumatic OGI with a minimum of 12mo follow-up and a median age at of 48.6y (range: 3-104y) were identified. Final best corrected visual acuity (BCVA) was independent from the time of repair, yet a statistically significant difference was present between the final BCVA and the zone of injury. Severe trauma presenting with an OTS score I (P<0.0001) or II (P<0.0001) revealed a significantly worse BCVA at last follow up when compared to the cohort with an OTS score >III. OGI associated RD was observed in 36/102 patients (35.3%), whereas post traumatic RD (defined as RD following 14d after OGI) occurred in 37 patients (36.3%). OGI associated RD did not correlate with the OTS and the zone of injury (P=0.193), yet post traumatic RD correlated significantly with zone III injuries (P=0.013). CONCLUSION The study shows a significant association between lower OTS score and zone III injury with lower final BCVA and a higher number of surgeries, but only zone III could be significantly associated with a higher rate of RD.
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Affiliation(s)
- Simon Dulz
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Vasilis Dimopoulos
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | | | - Robert Kromer
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Eileen Bigdon
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Martin Stephan Spitzer
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Christos Skevas
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
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Katz T, Druckiv V, Siebelmann S, Frings A, Skevas C. Prediction model of free flaps in microkeratome-assisted LASIK. PLoS One 2021; 16:e0255525. [PMID: 34469435 PMCID: PMC8409612 DOI: 10.1371/journal.pone.0255525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/17/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose To identify mechanical factors, as well as patients’ biometric and surgeons’ experience factors that correlate with the FF incidence in microkeratome (MK)-assisted LASIK and to construct a predictive model based on these parameters. Methods 55,700 consecutive LASIK treatments of 28,506 patients between January 2017 and April 2020 done by 50 surgeons in 10 centers, all with Sub Bowman Keratome (SBK) and 90μ head (OUP) were analyzed retrospectively for the incidence of FF and their correlation to mean keratometry, central corneal thickness, MK ring height and stop, as well as surgeons’ experience. A prediction model was built and tested for sensitivity and specificity. Results The incidence of FF using the SBK MK was 0.276%. Risk factors were low central corneal thickness, very flat (-1) or very thick (+2) ring height, and higher stop values (p<0.001). Mean keratometry and low surgeon experience were not correlated to FF incidence. A prediction model with a cut-off FF risk of 0.274%, a 76% specificity, and a 73% sensitivity was applied. Conclusions Free flaps are rarely seen in modern MK LASIK. However, the incidence of this complication using the SBK MK increases using higher stop values, very thick and very thin MK rings, and in eyes with thin corneas.
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Affiliation(s)
- Toam Katz
- Care Vision Academy, Germany
- Department of Ophthalmology, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | | | - Sebastian Siebelmann
- Care Vision Academy, Germany
- Department of Ophthalmology, University Hospital of Cologne, Valencia, Germany
| | - Andreas Frings
- Care Vision Academy, Germany
- Department of Ophthalmology, University Hospital Düsseldorf, Duesseldorf, Germany
- Augenarztpraxis Dr. Frings, Nürnberg, Germany
| | - Christos Skevas
- Department of Ophthalmology, University Hospital Hamburg Eppendorf, Hamburg, Germany
- * E-mail:
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Abdelrahim M, Esmail A, Katz T, Sharma S, Kalashnikova E, Malhotra M, Olshan P, Billings P, Aleshin A. P-108 Circulating tumor DNA for early relapse detection and monitoring disease status in patients with early-stage pancreatic adenocarcinoma. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Tzoran I, Katz T, Romano J, Brenner B. PO-112 Forthcoming study of a novel assay for the stratification of cancer patients' risk of thromboembolism. Thromb Res 2021. [DOI: 10.1016/s0049-3848(21)00183-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Steinberg J, Bußmann N, Frings A, Katz T, Druchkiv V, Linke SJ. Quality of life in stable and progressive 'early-stage' keratoconus patients. Acta Ophthalmol 2021; 99:e196-e201. [PMID: 32914586 DOI: 10.1111/aos.14564] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/15/2020] [Accepted: 07/02/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To analyse the vision-related quality of life (vr-QoL) in stable and progressive keratoconus (KC) patients with a still good visual acuity. METHODS Combined prospective/cross-sectional study design. The Refractive Status and Vision Profile (RSVP) and the National Eye Institute Visual Functioning - 25 (NEI-25) questionnaire were used in 16 emmetropic, 32 myopic and 56 KC patients, whereby KC patients with a stable (n = 26) and patients with a progressive stage (n = 30) and some of them before and after corneal cross-linking (CXL; n = 10) were included. All patients had a DCVA in at least one eye of ≥0.7 (decimal chart). RESULTS The analyses revealed a minor decline of the vr-QoL from emmetropes to myopes to early KC patients with a stable disease. Nonetheless, sociological subscales (i.e. 'social functioning', 'role difficulties' and 'dependency') did not display statistically significant differences comparing these groups. In progressive KC, we could demonstrate a statistically significant decline also of these sociological subscales, which did not improve after CXL. CONCLUSION Due to a still high and almost unaffected vr-QoL in early KC patients and the distinct decline after progression without rehabilitation after CXL, a reconsideration of current strategies to perform CXL only after a progression is diagnosed should be re-evaluated.
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Affiliation(s)
- Johannes Steinberg
- Department of Ophthalmology UKE ‐ University Medical Center Hamburg‐Eppendorf Martinistrasse 52 Hamburg20246Germany
- Martinistrasse 6420251Hamburg Germany
| | - Nils Bußmann
- Department of Ophthalmology UKE ‐ University Medical Center Hamburg‐Eppendorf Martinistrasse 52 Hamburg20246Germany
| | - Andreas Frings
- Department of Ophthalmology University Hospital Duesseldorf Moorenstraße 5 Duesseldorf40225Germany
- UCL Institute of Ophthalmology 11‐43 Bath St LondonEC1V 9ELUK
| | - Toam Katz
- Department of Ophthalmology UKE ‐ University Medical Center Hamburg‐Eppendorf Martinistrasse 52 Hamburg20246Germany
| | - Vasyl Druchkiv
- Department of Ophthalmology UKE ‐ University Medical Center Hamburg‐Eppendorf Martinistrasse 52 Hamburg20246Germany
| | - Stephan J. Linke
- Department of Ophthalmology UKE ‐ University Medical Center Hamburg‐Eppendorf Martinistrasse 52 Hamburg20246Germany
- Martinistrasse 6420251Hamburg Germany
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Frings A, Druchkiv V, Pose L, Linke SJ, Steinberg J, Katz T. Analysis of excimer laser treatment outcomes and corresponding angle κ in hyperopic astigmatism. J Cataract Refract Surg 2020; 45:952-958. [PMID: 31262484 DOI: 10.1016/j.jcrs.2019.01.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 01/18/2019] [Accepted: 01/29/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To investigate the prevalence of preoperative, intraoperative, and postoperative angle κ in hyperopic eyes and its effect on the refractive outcomes of excimer laser vision correction. SETTING University Hospital Hamburg and Care Vision Refractive Centers, Germany. DESIGN Retrospective multicenter study. METHODS Hyperopic patients after laser in situ keratomileusis and before retreatment because of hyperopic regression were included. Three treatment groups were defined based on the magnitude of preoperative angle κ defined as low (<0.25 mm), moderate (0.25 to 0.50 mm), or high (>0.50 mm). RESULTS The study analyzed 170 hyperopic eyes of 112 patients (mean age 29.8 years ± 10.04 [SD], range 21 to 62 years). The preoperative angle κ was low, moderate, or high in 23, 49, and 98 cases, respectively. In eyes with a preoperative angle κ of 0.25 mm or more, changes in the x-axes and y-axes of angle κ and its magnitude were statistically significant (P < .05) between preoperative and intraoperative measurements. In these eyes, intraoperative angle κ (offset) was statistically significantly smaller (P < .05), and Purkinje images were statistically significantly more caudal (P < .001). Treatment predictability was independent from using preoperative or intraoperative angle κ, and there were no statistically significant differences in efficacy or safety. CONCLUSIONS A preoperative magnitude of angle κ as high as 0.50 mm or higher was present in more than 50% of regressed hyperopic eyes. Measuring angle κ preoperatively did not reflect its real-time intraoperative magnitude. Using the preoperatively larger angle κ as an intraoperative offset might result in a too nasally centered ablation that causes topographic and optical drawbacks; therefore, centering the ablation based on the intraoperative measured offset is recommended.
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Affiliation(s)
- Andreas Frings
- University College London, Institute of Ophthalmology, England; Heinrich-Heine-University, Department of Ophthalmology, Düsseldorf, Germany; Care Vision Nuremberg, Nuremberg, Germany.
| | - Vasyl Druchkiv
- Medical University Hamburg, Hamburg, Germany; Care Vision Hamburg, Hamburg, Germany
| | - Lumi Pose
- Medical University Hamburg, Hamburg, Germany
| | - Stephan J Linke
- Care Vision Hamburg, Hamburg, Germany; University Hamburg, Department of Ophthalmology, Hamburg, Germany; zentrumsehstärke - Augenarztpraxis am UKE, Hamburg, Germany
| | - Johannes Steinberg
- Care Vision Hamburg, Hamburg, Germany; University Hamburg, Department of Ophthalmology, Hamburg, Germany; zentrumsehstärke - Augenarztpraxis am UKE, Hamburg, Germany
| | - Toam Katz
- Care Vision Nuremberg, Nuremberg, Germany; Care Vision Hamburg, Hamburg, Germany; University Hamburg, Department of Ophthalmology, Hamburg, Germany
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Grohmann C, Dimopoulos S, Bartz-Schmidt KU, Schindler P, Katz T, Spitzer MS, Skevas C. Surgical management of submacular hemorrhage due to n-AMD: a comparison of three surgical methods. Int J Retina Vitreous 2020; 6:27. [PMID: 32637155 PMCID: PMC7331168 DOI: 10.1186/s40942-020-00228-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 06/21/2020] [Indexed: 11/13/2022] Open
Abstract
Background To compare and assess the efficacy of three surgical methods for the treatment of acute submacular hemorrhage (ASH): pneumatic displacement with C2F6, in combination with intravitreal injection of bevacizumab and rtPA, pars plana vitrectomy (PPV) with intravitreal injection of gas (C2F6), bevacizumab and subretinal injection of recombinant tissue plasminogen activator (rtPA), pars plana vitrectomy (PPV) with intravitreal injection of gas (C2F6), bevacizumab and intravitreal injection of recombinant tissue plasminogen activator (rtPA). Methods The study included 85 patients with ASH. In the group without PPV (A), patients were treated with intravitreal injection of C2F6, bevacizumab and rtPA. In the second and third group, patients underwent a PPV, intravitreal injection of bevacizumab, pneumatic displacement with C2F6 and a subretinal (B) or intravitreal (C) injection of recombinant tissue plasminogen activator (rt PA). Results In group A, mean BCVA increased from preop logMAR 1.41 to 1.05, in group B from 1.46 to 1.28 and in group C from 1.63 to 1.33. In group A, CFT changed from 764 ± 340 μm at time point 0 to 246 ± 153 μm at time point 1, in group B from 987 ± 441 μm to 294 ± 166 μm and in group C from 642 ± 322 μm to 418 ± 364 μm. Patients had an average of 5 injections after surgery. Conclusion Our study demonstrates that the three methods are equally effective in improving the morphology and the BCVA of patients with ASH.
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Affiliation(s)
- Carsten Grohmann
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Spyridon Dimopoulos
- Department of Ophthalmology, Eberhard Karls University Medical Center, Tübingen, Germany
| | | | - Philipp Schindler
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Toam Katz
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Martin S Spitzer
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christos Skevas
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Katz T, Oh R, Thomson A, Widger J. ePS4.10 The principles of the Toyota Production System (TPS) applied to an inpatient food service model can improve nutritional outcomes for children with cystic fibrosis. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30319-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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von Beckerath AK, Katz T, Harfst A, Druchkiv V, Frings A. Diffractive trifocal lens implantation with or without excimer laser enhancement: is a touch-up procedure a negative predictor for refractive and subjective outcome? Graefes Arch Clin Exp Ophthalmol 2020; 258:1115-1121. [DOI: 10.1007/s00417-020-04628-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/06/2020] [Accepted: 02/12/2020] [Indexed: 11/30/2022] Open
Abstract
Abstract
Purpose
To investigate the refractive results of a LASIK enhancement and its impact on treatment safety, efficacy, predictability and patient reported outcome in eyes after clear lens extraction and diffractive trifocal lens implantation.
Methods
A retrospective cohort multicentre study of Care Vision Refractive Centres in Germany compared two groups of patients. Group 1 consisted of eyes that had non-toric MIOL surgery only, whereas group 2 had a consecutive laser enhancement after 3 months follow-up. Refractive and subjective results of the two groups were compared. Patient reported outcome measurements were assessed by using a 30-item questionnaire with four subscales.
(Spectacle Dependence, Eye Comfort, Freedom and Looking/Feeling Well). Refractive results were reported following standard reporting in refractive surgery.
Results
139 eyes of 79 patients were included in which either MIOL surgery or MIOL surgery plus LASIK enhancement had been performed between January and December 2017. UDVA reached 0.1logMAR (0.8; 20/25) in 94% in group 2 and 85% in group 1. Compared to preoperative CDVA no change in Snellen lines of CDVA was shown in 89% in group 1 and in 93% in group 2. Spectacle dependence (P = 0.41), eye comfort (P = 0.15), freedom (P = 0.48) and looking/feeling well (P = 0.45) showed no statistically significant difference between both the groups.
Conclusions
In patients with residual ametropia after MIOL implantation, LASIK provides a reliable, safe and efficient way to achieve the desired refractive outcome and patient satisfaction. We recommend performing Laser enhancement at 3 months after MIOL implantation (Bioptics) in trifocal MIOL patients that benefit from improvement of residual ametropia.
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Katz T, Tham A, Sutherland R, Garg M, Liu V, Tong C, Brunner R, Justine Q, Collins C, Ooi C. P328 Are we achieving energy density at the expense of micronutrient density? J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30620-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Steinberg J, Siebert M, Katz T, Frings A, Mehlan J, Druchkiv V, Bühren J, Linke SJ. Tomographic and Biomechanical Scheimpflug Imaging for Keratoconus Characterization: A Validation of Current Indices. J Refract Surg 2019; 34:840-847. [PMID: 30540367 DOI: 10.3928/1081597x-20181012-01] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 10/10/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE To analyze the potential benefit of the newly developed Tomography and Biomechanical Index (TBI) for early keratoconus screening. METHODS In this retrospective study, the discriminatory power of the corneal tomography Belin/Ambrósio Enhanced Ectasia Display (BAD-D) index and the newly developed Corvis Biomechanical Index (CBI) and TBI to differentiate between normal eyes, manifest keratoconus eyes (KCE), very asymmetric keratoconus eyes with ectasia (VAE-E), and their fellow eyes with either regular topography (VAE-NT) or regular topography and tomography (VAE-NTT) were analyzed by applying the t test (for normal distribution), Wilcoxon matched-pairs test (if not normally distributed), and receiver operating characteristic curve (ROC). The DeLong test was used to compare the area under the ROC (AUROC). Further, the cut-offs of the analyzed indices presented in a study by Ambrósio et al. from 2017 were applied in the study population to enable a cross-validation in an independent study population. RESULTS All indices demonstrated a high discriminative power when comparing normal and advanced keratoconus, which decreased when comparing normal and VAE-NT eyes and further when analyzing normal versus VAE-NTT eyes. The difference between the AUROCs reached a statistically significant level when comparing TBI versus BAD-D analyzing normal versus all included keratoconic eyes (P = .02). The TBI presented with the highest AUROCs throughout all conducted analyses when comparing different keratoconus stages, although not reaching a statistically significant level. Applying the cut-offs presented by Ambrósio et al. to differentiate between normal and VAE-NT in the study population, the accuracy was reproducible (accuracy in our study population with an optimized TBI cut-off: 0.72, with the cut-off defined by Ambrósio et al. 0.67). CONCLUSIONS The TBI enables karatoconus screening in topographical and tomographical regular keratoconic eyes. To further improve the screening accuray, prospective studies should be conducted. [J Refract Surg. 2018;34(12):840-847.].
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Mehlan J, Linke SJ, Skevas C, Steinberg J, Giannakakis K, Katz T. Safety and complications after three different surface ablation techniques with mitomycin C: a retrospective analysis of 2757 eyes. Graefes Arch Clin Exp Ophthalmol 2018; 257:217-223. [PMID: 30076471 DOI: 10.1007/s00417-018-4077-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 07/18/2018] [Accepted: 07/23/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND To evaluate the safety and spectrum of complications of three excimer laser surface ablation techniques (SATs) with an intraoperative application of mitomycin C (MMC) 0.02%. A retrospective, non-comparative large case series. METHODS SATs were performed on 2757 eyes with a preoperative spherical equivalent (SE) of - 4.41 ± 2.44 and a Wavelight Allegretto 200 platform. Ablation zone diameters between 6.0 and 7.0 mm were used according to mesopic pupil size. All patients were treated with an intraoperative application of MMC for 30 to 90 s depending on refractive error. The mean follow-up time was > 3 months (107 ± 24 days). Complication range and incidence were analyzed retrospectively and safety index was calculated. RESULTS Two thousand seven hundred and fifty-seven eyes met the inclusion criteria for surface ablation. Two thousand five hundred and seventy-three eyes were assigned to alcohol-assisted photorefractive keratectomy (APRK), 135 eyes to transepithelial photorefractive keratectomy (TPRK), and 49 eyes to off-flap epithelial laser in situ keratomileusis (EpiLASIK/EpiK). Overall, the safety index was 1.06 ± 0.28. Haze was graded according to the Fantes scale. Haze incidence rates were highest in the TPRK group (14.81%) and comparably low in APRK (2.95%) and EpiK (4.08%) groups. CONCLUSIONS Intraoperative topical application of MMC (0.02%) results in good safety and no severe side effects. However, highest incidence of haze was observed after TPRK. The more frequent peripheral localization of haze might be attributed to large ablation zones and the wavefront optimized ablation profile especially in the PTK modus of the laser platform.
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Affiliation(s)
- Juliane Mehlan
- Department of Ophthalmology, UKE - University Clinic Hamburg-Eppendorf, 52 Martinistrasse, 20246, Hamburg, Germany.
| | - Stephan Johannes Linke
- Department of Ophthalmology, UKE - University Clinic Hamburg-Eppendorf, 52 Martinistrasse, 20246, Hamburg, Germany.,Care-Vision Germany, 52 Martinistrasse, 20246, Hamburg, Germany.,zentrumsehstärke, 64 Martinistrasse, 20246, Hamburg, Germany
| | - Christos Skevas
- Department of Ophthalmology, UKE - University Clinic Hamburg-Eppendorf, 52 Martinistrasse, 20246, Hamburg, Germany
| | - Johannes Steinberg
- Care-Vision Germany, 52 Martinistrasse, 20246, Hamburg, Germany.,zentrumsehstärke, 64 Martinistrasse, 20246, Hamburg, Germany
| | - Konstantinos Giannakakis
- Augenarztpraxis Dr. med. Wilhelm Kröncke & Albrecht Zwick, 7 Grashoffstrasse, 27570, Bremerhaven, Germany
| | - Toam Katz
- Department of Ophthalmology, UKE - University Clinic Hamburg-Eppendorf, 52 Martinistrasse, 20246, Hamburg, Germany.,Care-Vision Germany, 52 Martinistrasse, 20246, Hamburg, Germany
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Steinberg J, Amirabadi NE, Frings A, Mehlan J, Katz T, Linke SJ. Keratoconus Screening With Dynamic Biomechanical In Vivo Scheimpflug Analyses: A Proof-of-Concept Study. J Refract Surg 2018; 33:773-778. [PMID: 29117418 DOI: 10.3928/1081597x-20170807-02] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 07/28/2017] [Indexed: 01/29/2023]
Abstract
PURPOSE This proof-of-concept study was designed to analyze the ability of in vivo biomechanical corneal analyses with the corneal visualization Scheimpflug technology (CorvisST; Oculus Optikgeräte, Wetzlar, Germany) to differentiate between normal eyes and eyes with manifest keratoconus after strictly eliminating the potential confounding factors intraocular pressure (IOP) and central corneal thickness (CCT). METHODS In this retrospective, cross-sectional study, after pairwise matching for CCT and IOP, 29 normal eyes and 29 keratoconic eyes (one eye from each patient) were selected as study population. Older CorvisST parameters and the new Corvis Biomechanical Index (CBI), including several biomechanical and one tomographic parameter, as well as an adjusted CBI (aCBI) (including only biomechanical parameters), were compared regarding their discriminative ability between both groups. RESULTS None of the CorvisST parameters of the former software version demonstrated statistically significant differences between normal and keratoconic eyes. On the other hand, the CBI and aCBI reached accuracies of 0.91 and 0.93, respectively, to discriminate between CCT- and IOP-matched normal and keratoconic eyes (CBI: [AUC/sensitivity/specificity]: 0.961/0.90/0.93; aCBI: [AUC/sensitivity/specificity]: 0.986/0.93/0.93). CONCLUSIONS This study demonstrated that the concept of keratoconus screening with the CorvisST is effective in differentiating keratoconic from non-keratoconic eyes. The next steps will be testing the indices in subclinical keratoconus cases and hopefully combining biomechanical analyses with already established topography and tomography indices to further improve current keratoconus screening. [J Refract Surg. 2017;33(11):773-778.].
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Frings A, Intert E, Steinberg J, Druchkiv V, Linke SJ, Katz T. Hyperopia shows the strongest association with LASIK retreatment. Acta Ophthalmol 2018; 96:e404. [PMID: 28771950 DOI: 10.1111/aos.13486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Andreas Frings
- Department of Ophthalmology; Heinrich-Heine-University Düsseldorf; Düsseldorf Germany
| | - Elisa Intert
- Department of Ophthalmology; University Medical Centre Hamburg-Eppendorf (UKE); Hamburg Germany
| | - Johannes Steinberg
- Department of Ophthalmology; University Medical Centre Hamburg-Eppendorf (UKE); Hamburg Germany
- Care Vision GmbH; University Medical Centre Hamburg-Eppendorf (UKE); Hamburg Germany
- Zentrumsehstärke; Hamburg Germany
| | - Vasyl Druchkiv
- Department of Ophthalmology; University Medical Centre Hamburg-Eppendorf (UKE); Hamburg Germany
- Care Vision GmbH; University Medical Centre Hamburg-Eppendorf (UKE); Hamburg Germany
| | - Stephan J. Linke
- Department of Ophthalmology; University Medical Centre Hamburg-Eppendorf (UKE); Hamburg Germany
- Care Vision GmbH; University Medical Centre Hamburg-Eppendorf (UKE); Hamburg Germany
- Zentrumsehstärke; Hamburg Germany
| | - Toam Katz
- Department of Ophthalmology; University Medical Centre Hamburg-Eppendorf (UKE); Hamburg Germany
- Care Vision GmbH; University Medical Centre Hamburg-Eppendorf (UKE); Hamburg Germany
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Scheibenberger D, Frings A, Steinberg J, Schüler H, Druchkiv V, Katz T, von Kodolitsch Y, Linke S. Ocular manifestation in Marfan syndrome: corneal biomechanical properties relate to increased systemic score points. Graefes Arch Clin Exp Ophthalmol 2018. [DOI: 10.1007/s00417-018-3946-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Frings A, Intert E, Steinberg J, Druchkiv V, Linke SJ, Katz T. Outcomes of retreatment after hyperopic laser in situ keratomileusis. J Cataract Refract Surg 2017; 43:1436-1442. [PMID: 29223233 DOI: 10.1016/j.jcrs.2017.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 08/01/2017] [Accepted: 08/04/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the efficacy, predictability, and safety of laser in situ keratomileusis (LASIK) retreatment in eyes with hyperopia. SETTING Multicenter refractive surgery centers and University Hospital, Germany. DESIGN Retrospective case series. METHODS This multicenter study included hyperopic patients with a preoperative difference between cycloplegic and manifest refraction of 1.00 diopter (D) or less who had LASIK retreatment based on manifest refraction. The refractive outcome was analyzed according to standard graphs for reporting the efficacy, predictability, and safety of refractive surgery. RESULTS One hundred thirteen eyes of 113 consecutive hyperopic patients were enrolled. Efficacy (P < .001) and safety (P = .004) were statistically significantly improved by retreatment without being negatively influenced by preoperative manifest spherical equivalent (SE), manifest cylinder, or keratometry. In cases still showing a trend toward undercorrection, retreatment resulted in 88 eyes (78.0%) being within ±0.50 D of the attempted correction. The optical zone (OZ) diameter of the retreatment did not correlate with efficacy, predictability, or safety. CONCLUSIONS Retreatment after hyperopic LASIK resulted in high efficacy, predictability, and safety outcomes. The efficacy and safety of the retreatment were not affected by preoperative manifest SE, manifest cylinder, keratometry, or OZ diameter.
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Affiliation(s)
- Andreas Frings
- From the Department of Ophthalmology (Frings), Heinrich-Heine-University Düsseldorf, Düsseldorf, the Department of Ophthalmology (Intert, Steinberg, Druchkiv, Linke, Katz), University Medical Centre Hamburg-Eppendorf, zentrumsehstärke (Steinberg, Linke) Hamburg, and Care Vision (Steinberg, Druchkiv, Linke, Katz), Hamburg, Germany.
| | - Elisa Intert
- From the Department of Ophthalmology (Frings), Heinrich-Heine-University Düsseldorf, Düsseldorf, the Department of Ophthalmology (Intert, Steinberg, Druchkiv, Linke, Katz), University Medical Centre Hamburg-Eppendorf, zentrumsehstärke (Steinberg, Linke) Hamburg, and Care Vision (Steinberg, Druchkiv, Linke, Katz), Hamburg, Germany
| | - Johannes Steinberg
- From the Department of Ophthalmology (Frings), Heinrich-Heine-University Düsseldorf, Düsseldorf, the Department of Ophthalmology (Intert, Steinberg, Druchkiv, Linke, Katz), University Medical Centre Hamburg-Eppendorf, zentrumsehstärke (Steinberg, Linke) Hamburg, and Care Vision (Steinberg, Druchkiv, Linke, Katz), Hamburg, Germany
| | - Vasyl Druchkiv
- From the Department of Ophthalmology (Frings), Heinrich-Heine-University Düsseldorf, Düsseldorf, the Department of Ophthalmology (Intert, Steinberg, Druchkiv, Linke, Katz), University Medical Centre Hamburg-Eppendorf, zentrumsehstärke (Steinberg, Linke) Hamburg, and Care Vision (Steinberg, Druchkiv, Linke, Katz), Hamburg, Germany
| | - Stephan J Linke
- From the Department of Ophthalmology (Frings), Heinrich-Heine-University Düsseldorf, Düsseldorf, the Department of Ophthalmology (Intert, Steinberg, Druchkiv, Linke, Katz), University Medical Centre Hamburg-Eppendorf, zentrumsehstärke (Steinberg, Linke) Hamburg, and Care Vision (Steinberg, Druchkiv, Linke, Katz), Hamburg, Germany
| | - Toam Katz
- From the Department of Ophthalmology (Frings), Heinrich-Heine-University Düsseldorf, Düsseldorf, the Department of Ophthalmology (Intert, Steinberg, Druchkiv, Linke, Katz), University Medical Centre Hamburg-Eppendorf, zentrumsehstärke (Steinberg, Linke) Hamburg, and Care Vision (Steinberg, Druchkiv, Linke, Katz), Hamburg, Germany
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Ortega-Usobiaga J, Llovet-Osuna F, Katz T, Djodeyre MR, Druchkiv V, Bilbao-Calabuig R, Baviera J. Comparison of 5468 retreatments after laser in situ keratomileusis by lifting the flap or performing photorefractive keratectomy on the flap. ACTA ACUST UNITED AC 2017; 93:60-68. [PMID: 28651810 DOI: 10.1016/j.oftal.2017.05.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/22/2017] [Accepted: 05/23/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess visual outcomes of retreatment after laser in situ keratomileusis (LASIK) by lifting the flap or performing photorefractive keratectomy (PRK) on the flap, as well as to establish whether there was an increased risk of epithelial ingrowth (EIG) when LASIK and lifting of the flap are separated by a long time interval and to determine the incidence of corneal haze after PRK. METHODS Retrospective study of 4077 patients (5468 eyes) who underwent LASIK and subsequent retreatment were reviewed in order to study their visual results and identify cases of EIG and corneal haze. RESULTS Enhancements included 5196 eyes from 3876 patients that were retreated by lifting the flap, and 272 eyes from 201 patients that were retreated by PRK on the flap. No statistically significant differences were found between the retreatments in terms of predictability, efficacy, and safety. A total of 704 cases of EIG were found after lifting the flap, for which surgical cleansing was necessary in 70. Surgical cleansing decreased the efficacy index when compared with patients with EIG who did not need cleansing (P=.01). Differences in terms of safety and predictability were not statistically significant. The incidence of corneal haze after ablation of the surface of the previous flap was 14.34%, although none of these cases were clinically relevant. CONCLUSIONS Visual outcomes were similar between patients who were retreated by lifting the flap and those who underwent PRK. The incidence of EIG when the flap was lifted was 13.55%. The incidence of EIG increases with the time elapsed between the primary procedure and retreatment.
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Affiliation(s)
- J Ortega-Usobiaga
- Departamento de Catarata y Cirugía Refractiva, Clínica Baviera, Bilbao, España.
| | - F Llovet-Osuna
- Departamento de Catarata y Cirugía Refractiva, Clínica Baviera, Madrid, España
| | - T Katz
- Departamento de Catarata y Cirugía Refractiva, Care Vision, Hamburgo, Alemania; Departamento de Oftalmología, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburgo, Alemania
| | - M R Djodeyre
- Departamento de Catarata y Cirugía Refractiva, Clínica Baviera, Zaragoza, España
| | - V Druchkiv
- Departamento de Investigación y Desarrollo, Clínica Baviera, Valencia, España
| | - R Bilbao-Calabuig
- Departamento de Catarata y Cirugía Refractiva, Clínica Baviera, Madrid, España
| | - J Baviera
- Departamento de Catarata y Cirugía Refractiva, Clínica Baviera, Valencia, España
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Frings A, Steinberg J, Linke SJ, Druchkiv V, Katz T. [Multifocal intraocular lens (MIOL) surgery in young non-presbyopic ametropes : Reasonable and safe?]. Ophthalmologe 2016; 114:722-727. [PMID: 27913863 DOI: 10.1007/s00347-016-0401-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Refractive lens exchange and implantation of a multifocal intraocular lens (MIOL) is mainly advised for ametropes with presbyopia. Non-presbyopic young ametropes who wish spectacle-independence are usually treated with corneal refractive surgery or phakic lenses. OBJECTIVES This retrospective case series aimed to analyse the refractive and subjective satisfaction outcome after MIOL surgery in both eyes of non-presbyopic ametropes where other treatment options were not possible. MATERIALS AND METHODS This retrospective case series comprised consecutively treated 32 eyes of 16 patients (5 myopic, 11 hyperopic patients; mean age 31 ± 6 years) who wished spectacle-independence and thus received an aspheric bifocal biconvex refractive-diffractive single-piece MIOL (Acri.Lisa 366/809, Carl Zeiss Meditec AG). Refractive data prior to and after surgery as well as subjective satisfaction at the 1‑year follow-up examination were assessed. RESULTS Related to distance corrected near visual acuity myopic eyes had a median efficacy index (EI) of 0.92 (±0.20) and hyperopes of 0.91 (±0.12) (P = 0.415). For intermediate vision, in both groups a lower EI (<0.5; P = 0.188) resulted in lower subjective satisfaction, which was higher for near and distance vision. Some of hyperopic patients reported limitations in near and distance vision, only one hyperopic patient would not have chosen this surgery again. None had a related complication during the follow-up. CONCLUSIONS When neither laser refractive surgery nor implantation of a phakic lens is possible, young non-presbyopic ametropes do profit from MIOL surgery with an aspheric bifocal biconvex refractive-diffractive MIOL.
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Affiliation(s)
- A Frings
- Univ.-Klinik für Augenheilkunde, Universitätsklinik Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - J Steinberg
- Univ.-Klinik für Augenheilkunde, Universitätsklinik Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.,Care Vision GmbH, Hamburg, Deutschland.,zentrumsehstärke, Augenarztpraxis am UKE, Hamburg, Deutschland
| | - S J Linke
- Univ.-Klinik für Augenheilkunde, Universitätsklinik Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.,Care Vision GmbH, Hamburg, Deutschland.,zentrumsehstärke, Augenarztpraxis am UKE, Hamburg, Deutschland
| | - V Druchkiv
- Univ.-Klinik für Augenheilkunde, Universitätsklinik Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - T Katz
- Univ.-Klinik für Augenheilkunde, Universitätsklinik Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland. .,Care Vision GmbH, Hamburg, Deutschland.
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Steinberg J, Frings A, Mousli A, Casagrande MK, Druchkiv V, Katz T, Linke SJ. New Scheimpflug Dynamic In Vivo Curve Analyses to Characterize Biomechanical Changes of the Cornea After Cross-linking for Progressive Keratoconus. J Refract Surg 2016; 32:34-9. [PMID: 26812712 DOI: 10.3928/1081597x-20151207-09] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 10/21/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the effect of corneal cross-linking (CXL) in progressive keratoconus by applying in vivo static and dynamic Scheimpflug analyses. METHODS In this longitudinal retrospective study, corneal topography and tomography (Pentacam HD) and dynamic Scheimpflug-based biomechanical analyses (CorvisST [CST]) of 24 eyes of 24 patients with progressive keratoconus before and 6 months after CXL were reviewed. New dynamic curve analyses, provided by Oculus Optikgeräte, were performed to analyze corneal dynamics throughout the entire response to the CST air puff impulse. RESULTS Besides subtle changes of topography and tomography, only the CorvisST predefined parameters peak distance (-0.5 mm) and radius of the intended cornea (+0.5 mm; P < .05) demonstrated statistically significant differences 6 months after CXL. Using new dynamic curve analyses, additional distinct changes of the corneal biomechanical characteristics after CXL were noted. CONCLUSIONS Published results of corneal biomechanical changes after CXL for progressive keratoconus based on single, predefined CST parameters are inconsistent. The new dynamic curve analyses demonstrate distinct changes of the biomechanical properties of the cornea and might therefore be the next step in understanding in vivo analyses of corneal biomechanics.
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Frings A, Steinberg J, Druchkiv V, Linke SJ, Katz T. Pseudolentogenic astigmatic effect of multifocal intraocular lenses: non-corneal ocular residual astigmatism (N-CORA) as a new parameter in astigmatic change analysis. Int Ophthalmol 2016; 37:957-964. [PMID: 27665612 DOI: 10.1007/s10792-016-0359-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 09/18/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE This study was initiated to introduce the term non-corneal ocular residual astigmatism (N-CORA) as a new parameter in astigmatic change analysis after implantation of two different types of non-toric, multifocal intraocular lenses (MIOL). METHODS Seventy-two eyes from 72 consecutive patients after MIOL surgery were studied in terms of a retrospective, cross-sectional data analysis. Two types of spherical MIOL were used. Surgical technique in all patients was a 2.4-mm incision phacoemulsification, performed by one surgeon. To investigate the magnitude and axis of astigmatic changes, the true corneal astigmatism and Alpins vector method were applied. RESULTS There were no statistically significant between-group differences related to the preoperative refraction or ocular residual astigmatism (ORA). After surgery, the mean refractive surgically induced astigmatism (RSIA) and the topographic SIA (TSIA) did not differ significantly between the lenses. The magnitude and orientation of ORA and N-CORA changed after surgery. CONCLUSIONS There are no statistically significant differences in postoperative ORA in magnitude or axis when implanting different types of MIOL. The similarity of N-CORA between both MIOL types shows that both diffractive and refractive asymmetric MIOLs with plate haptics have the same pseudolentogenic astigmatic effect which could be presented in terms of the newly introduced parameter N-CORA.
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Affiliation(s)
- Andreas Frings
- Department of Ophthalmology, University Medical Centre Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany.
| | - Johannes Steinberg
- Department of Ophthalmology, University Medical Centre Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
- Care Vision Refractive Centers, Hamburg, Germany
- zentrumsehstärke, Augenarztpraxis am UKE, Hamburg, Germany
| | - Vasyl Druchkiv
- Department of Ophthalmology, University Medical Centre Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | - Stephan J Linke
- Department of Ophthalmology, University Medical Centre Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
- Care Vision Refractive Centers, Hamburg, Germany
- zentrumsehstärke, Augenarztpraxis am UKE, Hamburg, Germany
| | - Toam Katz
- Department of Ophthalmology, University Medical Centre Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
- Care Vision Refractive Centers, Hamburg, Germany
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Katz T, Steinberg J, Druchkiv V, Linke SJ, Frings A. Ocular residual astigmatism (ORA) in pre-cataract eyes prior to and after refractive lens exchange. Int Ophthalmol 2016; 37:859-865. [PMID: 27624172 DOI: 10.1007/s10792-016-0332-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 08/29/2016] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to analyze ocular residual astigmatism (ORA) before and after implantation of two different optical types of non-toric multifocal intraocular lenses (MIOL) in pre-cataract patients. This retrospective cohort study analyzed 72 eyes from 72 consecutive patients after MIOL surgery . To investigate magnitude and axis of astigmatic changes, the concepts of true corneal astigmatism and Alpins vector method were applied. There were no statistically significant between-group differences prior to surgery. The mean refractive surgically induced astigmatism (RSIA) (P = 0.063) and the topographic SIA (TSIA) (P = 0.828) did not differ significantly between the lenses, and the summated vector mean for ORA was reduced in terms of magnitude by approximately 0.30 Diopter. ORA in pseudophakic eyes mainly results from the posterior corneal surface and less from IOL tilting, postoperative posterior capsule shrinkage, or secondary cataract.
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Affiliation(s)
- Toam Katz
- Department of Ophthalmology, University Medical Centre Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
- Care Vision Refractive Centers, Hamburg, Germany
| | - Johannes Steinberg
- Department of Ophthalmology, University Medical Centre Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
- Care Vision Refractive Centers, Hamburg, Germany
- zentrumsehstärke, Augenarztpraxis am UKE, Hamburg, Germany
| | - Vasyl Druchkiv
- Department of Ophthalmology, University Medical Centre Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | - Stephan J Linke
- Department of Ophthalmology, University Medical Centre Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
- Care Vision Refractive Centers, Hamburg, Germany
- zentrumsehstärke, Augenarztpraxis am UKE, Hamburg, Germany
| | - Andreas Frings
- Department of Ophthalmology, University Medical Centre Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany.
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Mehlan J, Steinberg J, Traber L, Katz T, Linke SJ. Recurrence rate and subjective symptoms after standardized (Hamburg protocol) phototherapeutic keratectomy on recurrent corneal erosions. Graefes Arch Clin Exp Ophthalmol 2016; 254:2005-2009. [DOI: 10.1007/s00417-016-3470-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 06/21/2016] [Accepted: 08/09/2016] [Indexed: 11/29/2022] Open
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Abstract
INTRODUCTION Multiple myeloma (MM) is an incurable, genetically heterogeneous malignancy of plasma cells that secrete non-functioning immunoglobulins and present high proteasome activity. MM is characterized by bone marrow infiltration leading to multiple lytic bone lesions, cytopenia and increased rate of thrombotic events. Microvesicles (MVs) include exosomes (30-100 nm) and microparticles (0.1-1 micron) shed from various cells and expressing antigens reflecting their cellular origin. MVs are involved in thrombosis, inflammation and cancer.However, the effect of MM-MVs on disease progression and their mechanism of action are unclear. We assume that MVs play a role in the interaction between malignant plasma cells and mesenchymal and endothelial cells (EC). AIM To characterize MM-MVs and investigate their effects on microenvironment cells. MATERIALS AND METHODS MVs were isolated from MM cell line RPMI 8226 untreated or treated with bortezomib and from peripheral blood (PB) and bone marrow (BM) of MM patients (n=13) and healthy controls (n=14). MM-MV size, concentration and cell origin were measured by Nanosite and FACS. Protein content was evaluated by protein arrays and ELISA. Coagulation and proteasome activity were assessed using chromogenic assays. Migratory capacity (migration assay), proliferative rate (XTT assay) and cell-signaling effects (Western blot analysis) of MVs on BM-mesenchymal and ECs were analyzed. RESULTS MM cells exhibited high MV shedding rate, which further increased with the exposure to bortezomib. Significant elevation in MV production was found in MM patients compared to controls. MM-MVs expressed membrane MM markers (syndecan-1/ CD138, CD38), coagulation factor (TF, TFPI, EPCR, TM) and angiogenic factors (VEGFR1, VEGFR2, and CD31). MM-MVs contained high levels of growth factors (Angiogenin, PDGF-BB and VEGF) and displayed procoagulant and proteasome activity. MM-MVs penetrated cells and affected their function. MVs of untreated cells and patient MVs increased EC and mesenchymal cell migration and EC proliferation, while MVs obtained from bortezomib-treated cells decreased these effects. MVs of untreated cells increased ERK1/2 and c-Jun phosphorylation in ECs (by 6.15 and 1.84 fold) but did not affect MAPKAPK-2. MVs of bortezomib-treated cells reduced c-Jun phosphorylation in ECs. CONCLUSIONS MM cells are characterized by high shedding rate of MVs. They are pro-coagulants and increase EC thrombogenicity, suggesting their involvement in MM-related thrombosis. MVs contain high levels of angiogenic factors that affect mesenchymal and EC, induce cell migration and proliferation via specific signal transductions. MVs exposed to bortezomib display lower levels of angiogenic factors, which limits proliferation and migration of MVs, reflecting the efficacy of therapy and MM dynamics.
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Affiliation(s)
- M Zarfati
- Bruce Rappaport Faculty of Medicine, Technion
| | - T Katz
- Bruce Rappaport Faculty of Medicine, Technion; Department of Hematology and Bone Marrow Transplantation, Rambam Health Care; Haifa, Israel
| | - I Avivi
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care; Haifa, Israel
| | - B Brenner
- Bruce Rappaport Faculty of Medicine, Technion; Department of Hematology and Bone Marrow Transplantation, Rambam Health Care; Haifa, Israel
| | - A Aharon
- Bruce Rappaport Faculty of Medicine, Technion; Department of Hematology and Bone Marrow Transplantation, Rambam Health Care; Haifa, Israel
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Abstract
Purpose To analyze the refractive and keratometric stability in hyperopic astigmatic laser in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK) during the first 6 months after surgery. Patients and methods This retrospective cross-sectional study included 97 hyperopic eyes; 55 were treated with LASIK and 42 with PRK. Excimer ablation for all eyes was performed using the ALLEGRETTO excimer laser platform using a mitomycin C for PRK and a mechanical microkeratome for LASIK. Keratometric and refractive data were analyzed during three consecutive follow-up intervals (6 weeks, 3 months, and 6 months). The corneal topography was obtained using Scheimpflug topography, and subjective refractions were acquired by expert optometrists according to a standardized protocol. Results After 3 months, mean keratometry and spherical equivalent were stable after LASIK, whereas PRK-treated eyes presented statistically significant (P<0.001) regression of hyperopia. In eleven cases, hyperopic regression of >1 D occurred. The optical zone diameter did not correlate with the development of regression. Conclusion After corneal laser refractive surgery, keratometric changes are followed by refractive changes and they occur up to 6 months after LASIK and for at least 6 months after PRK, and therefore, caution should be applied when retreatment is planned during the 1st year after surgery because hyperopic refractive regression can lead to suboptimal visual outcome. Keratometric and refractive stability is earlier achieved after LASIK, and therefore, retreatment may be independent of late regression.
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Affiliation(s)
- Andreas Frings
- Department of Ophthalmology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Gisbert Richard
- Department of Ophthalmology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Ophthalmologikum an der Alster, Hamburg, Germany
| | - Johannes Steinberg
- Department of Ophthalmology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; zentrumsehstärke, Hamburg, Germany; CARE Vision Germany GmbH, Hamburg, Germany
| | - Vasyl Druchkiv
- Department of Ophthalmology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; CARE Vision Germany GmbH, Hamburg, Germany
| | - Stephan Johannes Linke
- Department of Ophthalmology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; zentrumsehstärke, Hamburg, Germany; CARE Vision Germany GmbH, Hamburg, Germany
| | - Toam Katz
- Department of Ophthalmology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; CARE Vision Germany GmbH, Hamburg, Germany
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Frings A, Steinberg J, Druchkiv V, Linke SJ, Katz T. Role of preoperative cycloplegic refraction in LASIK treatment of hyperopia. Graefes Arch Clin Exp Ophthalmol 2016; 254:1399-404. [PMID: 26935202 DOI: 10.1007/s00417-016-3308-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 02/11/2016] [Accepted: 02/18/2016] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Previous studies have suggested that, to improve refractive predictability in hyperopic LASIK treatments, preoperative cycloplegic or manifest refraction, or a combination of both, could be used in the laser nomogram. We set out to investigate (1) the prevalence of a high difference between manifest and cycloplegic spherical equivalent in hyperopic eyes preoperatively, and (2) the related predictability of postoperative keratometry. METHODS Retrospective cross-sectional data analysis of consecutive treated 186 eyes from 186 consecutive hyperopic patients (mean age 42 [±12] years) were analyzed. Excimer ablation for all eyes was performed using a mechanical microkeratome (SBK, Moria, France) and an Allegretto excimer laser platform. Two groups were defined according to the difference between manifest and cycloplegic spherical equivalent which was defined as ≥1.00 diopter (D); the data was analyzed according to refractive outcome in terms of refractive predictability, efficacy, and safety. RESULTS In 24 eyes (13 %), a preoperative difference of ≥1.00D between manifest spherical equivalent and cycloplegic spherical equivalent (= MCD) occurred. With increasing preoperative MCD, the postoperative achieved spherical equivalent showed hyperopic regression after 3 months. There was no statistically significant effect of age (accommodation) or optical zone size on the achieved spherical equivalent. CONCLUSIONS A difference of ≥1.00D occurs in about 13 % of hyperopia cases. We suggest that hyperopic correction should be based on the manifest spherical equivalent in eyes with preoperative MCD <1.00D. If the preoperative MCD is ≥1.00D, treatment may produce manifest undercorrection, and therefore we advise that the patient should be warrned about lower predictability, and suggest basing conclusions on the arithmetic mean calculated from the preoperative manifest and cycloplegic spheres.
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Affiliation(s)
- Andreas Frings
- Department of Ophthalmology, University Medical Centre Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany.
| | - Johannes Steinberg
- Department of Ophthalmology, University Medical Centre Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | - Vasyl Druchkiv
- Department of Ophthalmology, University Medical Centre Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | - Stephan J Linke
- Department of Ophthalmology, University Medical Centre Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | - Toam Katz
- Department of Ophthalmology, University Medical Centre Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
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Huelle JO, Druchkiv V, Habib NE, Richard G, Katz T, Linke SJ. Intraoperative aberrometry-based aphakia refraction in patients with cataract: status and options. Br J Ophthalmol 2016; 101:97-102. [DOI: 10.1136/bjophthalmol-2015-307594] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 12/08/2015] [Accepted: 01/31/2016] [Indexed: 11/04/2022]
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Frings A, Markau N, Katz T, Stemplewitz B, Skevas C, Druchkiv V, Wagenfeld L. Visual recovery after retinal detachment with macula-off: is surgery within the first 72 h better than after? Br J Ophthalmol 2016; 100:1466-1469. [DOI: 10.1136/bjophthalmol-2015-308153] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 12/30/2015] [Accepted: 01/19/2016] [Indexed: 11/03/2022]
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Katz T, Frings A, Richard G, Steinberg J, Druchkiv V, Linke SJ. Flap-induced astigmatism in eyes with sphere myopia correction: Superior hinge using a rotating microkeratome versus nasal hinge using a linear microkeratome. J Cataract Refract Surg 2015; 41:1160-7. [PMID: 26189377 DOI: 10.1016/j.jcrs.2014.08.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 08/22/2014] [Accepted: 08/23/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE To compare the effect of a rotating microkeratome (M2) and a linear microkeratome (SBK) on the change in the astigmatic component in eyes with preoperative plano refractive cylinder. SETTING University Medical Centre Hamburg-Eppendorf, Hamburg, Germany. DESIGN Retrospective case series. METHODS An Allegretto excimer laser was used to perform laser ablation in myopic eyes of consecutive patients. The laser in situ keratomileusis (LASIK) procedure included mechanical flap preparation using a microkeratome, either a linear type with a single-use 90 μm head to create a nasal hinge or a rotating type with a single-use 90 μm head to create a superior hinge. The Alpins vector method was applied to describe the effects of LASIK on postoperative refractive cylinder. RESULTS The study evaluated 1045 eyes of 852 patients. Although the mean overall efficacy and safety indices indicate the procedure was highly precise, safe, and efficient, there were statistically significant differences in surgically induced astigmatism (SIA) between the microkeratomes (P = .002). The postoperative refractive cylinder (ie, SIA) was 0.75 diopter (D) or more in 116 eyes (11.1%), 44 (12.8%) of 344 linear cases and 72 (10.3%) of 701 rotating cases. Independent of the type of microkeratome used, the SIA was slightly higher in eyes treated first; the mean magnitude of the induced astigmatism was 0.35 D. CONCLUSIONS In approximately 10% of eyes with preoperative plano refractive myopia, the astigmatic component tended to be overcorrected. Nevertheless, independent of the type of microkeratome, the maximum mean magnitude of refractive cylinder documented was 0.35 D. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Toam Katz
- From the Department of Ophthalmology (Katz, Richard, Steinberg, Druchkiv, Linke), University Medical Centre Hamburg-Eppendorf, Hamburg, and the Department of Ophthalmology (Frings), University Hospital Erlangen-Nuremberg, Erlangen, Germany
| | - Andreas Frings
- From the Department of Ophthalmology (Katz, Richard, Steinberg, Druchkiv, Linke), University Medical Centre Hamburg-Eppendorf, Hamburg, and the Department of Ophthalmology (Frings), University Hospital Erlangen-Nuremberg, Erlangen, Germany.
| | - Gisbert Richard
- From the Department of Ophthalmology (Katz, Richard, Steinberg, Druchkiv, Linke), University Medical Centre Hamburg-Eppendorf, Hamburg, and the Department of Ophthalmology (Frings), University Hospital Erlangen-Nuremberg, Erlangen, Germany
| | - Johannes Steinberg
- From the Department of Ophthalmology (Katz, Richard, Steinberg, Druchkiv, Linke), University Medical Centre Hamburg-Eppendorf, Hamburg, and the Department of Ophthalmology (Frings), University Hospital Erlangen-Nuremberg, Erlangen, Germany
| | - Vasyl Druchkiv
- From the Department of Ophthalmology (Katz, Richard, Steinberg, Druchkiv, Linke), University Medical Centre Hamburg-Eppendorf, Hamburg, and the Department of Ophthalmology (Frings), University Hospital Erlangen-Nuremberg, Erlangen, Germany
| | - Stephan J Linke
- From the Department of Ophthalmology (Katz, Richard, Steinberg, Druchkiv, Linke), University Medical Centre Hamburg-Eppendorf, Hamburg, and the Department of Ophthalmology (Frings), University Hospital Erlangen-Nuremberg, Erlangen, Germany
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Steinberg J, Aubke‐Schultz S, Frings A, Hülle J, Druchkiv V, Richard G, Katz T, Linke SJ. Correlation of the KISA% index and Scheimpflug tomography in 'normal', 'subclinical', 'keratoconus-suspect' and 'clinically manifest' keratoconus eyes. Acta Ophthalmol 2015; 93:e199-207. [PMID: 25873278 DOI: 10.1111/aos.12590] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 10/06/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE To analyse tomographic changes in eyes classified as 'normal', 'keratoconus-suspect' and 'clinically manifest keratoconus' based on the established KISA% definition of Rabinowitz and Rasheed and to develop the category of 'subclinical keratoconus eyes' to expand the classification into a 'subtopographic' range. METHODS Tomographic and topographic analyses of 670 eyes performed with a rotating Scheimpflug imaging system (Pentacam(®), Oculus Inc., Wetzlar, Germany) were retrospectively analysed. Based on the KISA% keratoconus classification system, eyes were assigned to a 'normal', 'keratoconus-suspect' or 'manifest keratoconus' group. In addition, a new group of 'subclinical keratoconus eyes' was analysed, comprising unsuspicious fellow eyes of patients with keratoconus. T-tests, Wilcoxon rank-sum test, receiver operating characteristics (ROC) and robust regression analyses were performed to correlate tomographic parameters with the increasing KISA% index. RESULTS KISA%-grouped keratoconus eyes showed robust tomographic changes. By adding the subclinical group, although the concurrent topography was unchanged, we were able to demonstrate statistically significant changes for almost all tomographic parameters (parameters with highest sensitivity/specificity: ART_max, [0.69/0.69], BAD_D [0.66/0.66]). The highest coefficient of determination (R(2)) with the KISA% index was demonstrated for Ele_f_max (R(2) = 0.70), Ele_f_TP (R(2) = 0.69), Ele_b_TP (R(2) = 0.69) and BAD_D (R(2) = 0.68). CONCLUSION We recommend the use of the expanded KISA% index (eKISA% index) as the basis for the definition of keratoconus and normal groups in future keratoconus research projects.
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Affiliation(s)
- Johannes Steinberg
- Department of Ophthalmology UKE ‐ University Medical Center Hamburg‐Eppendorf Hamburg Germany
- Care‐Vision Germany University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Silke Aubke‐Schultz
- Department of Ophthalmology UKE ‐ University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Andreas Frings
- Department of Ophthalmology UKE ‐ University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Jan Hülle
- South West Peninsula Postgraduate Medical Education School of Ophthalmology Plymouth UK
| | - Vasyl Druchkiv
- Department of Ophthalmology UKE ‐ University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Gisbert Richard
- Department of Ophthalmology UKE ‐ University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Toam Katz
- Department of Ophthalmology UKE ‐ University Medical Center Hamburg‐Eppendorf Hamburg Germany
- Care‐Vision Germany University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Stephan J. Linke
- Department of Ophthalmology UKE ‐ University Medical Center Hamburg‐Eppendorf Hamburg Germany
- Care‐Vision Germany University Medical Center Hamburg‐Eppendorf Hamburg Germany
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Frings A, Richard G, Steinberg J, Skevas C, Druchkiv V, Katz T, Linke SJ. LASIK for spherical refractive myopia: effect of topographic astigmatism (ocular residual astigmatism, ORA) on refractive outcome. PLoS One 2015; 10:e0124313. [PMID: 25875476 PMCID: PMC4398356 DOI: 10.1371/journal.pone.0124313] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 03/11/2015] [Indexed: 11/23/2022] Open
Abstract
Purpose In eyes with a preoperative plano refractive cylinder, it would appear that there is no rationale for astigmatic treatment. The aim of this retrospective, cross-sectional data analysis was to determine the amount of topographic astigmatism in refractive plano eyes that results in reduced efficacy after myopic laser in situ keratomileusis (LASIK). Methods This study included 267 eyes from 267 consecutive myopic patients with a refractive plano cylinder. Receiver operating characteristic analysis was used to find the cut-off values of preoperative ocular residual astigmatism (= topographic astigmatism) that can best discriminate between groups of efficacy and safety indices in preoperative plano refractive cylinder eyes. Results Preoperative ocular residual astigmatism (ORA) (or topographic astigmatism) of ≤0.9 diopters (D) resulted in an efficacy index of at least 0.8 statistically significantly more frequently than eyes with a preoperative ORA of >0.9 D. Eyes with a high ORA preoperatively also had a high ORA postoperatively. Regression analysis showed that each diopter of preoperative ORA reduced efficacy by 0.07. Conclusion A preoperative corneal astigmatism of ≥0.9 D could (partially) be taken into account in the LASIK design, even if the subjective refractive astigmatism is neutral.
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Affiliation(s)
- Andreas Frings
- Department of Ophthalmology, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Gisbert Richard
- Department of Ophthalmology, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Johannes Steinberg
- Department of Ophthalmology, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christos Skevas
- Department of Ophthalmology, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Vasyl Druchkiv
- Department of Ophthalmology, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Toam Katz
- Department of Ophthalmology, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Stephan J Linke
- Department of Ophthalmology, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
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Linke SJ, Ren L, Frings A, Steinberg J, Wöllmer W, Katz T, Reimer R, Hansen NO, Jowett N, Richard G, Dwayne Miller RJ. [Perspectives of laser-assisted keratoplasty: current overview and first preliminary results with the picosecond infrared laser (λ = 3 µm)]. Ophthalmologe 2015; 111:523-30. [PMID: 24942118 DOI: 10.1007/s00347-013-2995-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND This article provides a review of the current state of laser-assisted keratoplasty and describes a first proof of concept study to test the feasibility of a new mid-infrared (MIR) picosecond laser to perform applanation-free corneal trephination. METHODS The procedure is based on a specially adapted laser system (PIRL-HP2-1064 OPA-3000, Attodyne, Canada) which works with a wavelength of 3,000 ± 90 nm, a pulse duration of 300 ps and a repetition rate of 1 kHz. The picosecond infrared laser (PIRL) beam is delivered to the sample by a custom-made optics system with an implemented scanning mechanism. Corneal specimens were mounted on an artificial anterior chamber and subsequent trephination was performed with the PIRL under stable intraocular pressure conditions. RESULTS A defined corneal ablation pattern, e.g. circular, linear, rectangular or disc-shaped, can be selected and its specific dimensions are defined by the user. Circular and linear ablation patterns were employed for the incisions in this study. Linear and circular penetrating PIRL incisions were examined by macroscopic inspection, histology, confocal microscopy and environmental scanning electron microscopy (ESEM) for characterization of the incisional quality. Using PIRL reproducible and stable incisions could be made in human and porcine corneal samples with minimal damage to the surrounding tissue. CONCLUSION The PIRL laser radiation in the mid-infrared spectrum with a wavelength of 3 µm is exactly tuned to one of the dominant vibrational excitation bands of the water molecule, serves as an effective tool for applanation-free corneal incision and might broaden the armamentarium of corneal transplant surgery.
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Affiliation(s)
- S J Linke
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland,
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Frings A, Linke SJ, Bauer EL, Druchkiv V, Katz T, Steinberg J. Effects of laser in situ keratomileusis (LASIK) on corneal biomechanical measurements with the Corvis ST tonometer. Clin Ophthalmol 2015; 9:305-11. [PMID: 25709393 PMCID: PMC4334333 DOI: 10.2147/opth.s76491] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose This study was initiated to evaluate biomechanical changes using the Corvis ST tonometer (CST) on the cornea after laser in situ keratomileusis (LASIK). Setting University Medical Center Hamburg-Eppendorf, Germany, and Care Vision Refractive Centers, Germany. Design Retrospective cohort study. Methods This retrospective study included 37 eyes of 37 refractive patients. All CST measurements were performed 1 day before surgery and at the 1-month follow-up examination. The LASIK procedure included mechanical flap preparation using a Moria SBK microkeratome and an Allegretto excimer laser platform. Results Statistically significant differences were observed for mean first applanation length, mean first and second deflection lengths, mean first and second deflection amplitudes, radius of curvature, and peak distance. Significant positive correlations were found between the change (Δ) of radius of curvature and manifest refraction spherical equivalent (MRSE), ablation depth, and Δintraocular pressure as well as between AD and ΔHC-time. Each diopter of myopic correction in MRSE resulted in an increase in Δradius of curvature of 0.2 mm. Conclusion Several CST parameters were statistically significantly altered by LASIK, thereby indicating that flap creation, ablation, or both, significantly change the ability of the cornea to absorb or dissipate energy.
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Affiliation(s)
- Andreas Frings
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Stephan J Linke
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany ; Care Vision Refractive Center, Hamburg, Germany
| | - Eva L Bauer
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Vasyl Druchkiv
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Toam Katz
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany ; Care Vision Refractive Center, Hamburg, Germany
| | - Johannes Steinberg
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany ; Care Vision Refractive Center, Hamburg, Germany
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Frings A, Görsch I, Druchkiv V, Katz T, Linke S, Steinberg J, Richard G, Neuhaus-Richard I. Does outside environmental humidity influence the outcome of laser refractive surgery? Results from the Hamburg Weather Study. J Clin Ophthalmol Res 2015. [DOI: 10.4103/2320-3897.163261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Neuhaus-Richard I, Frings A, Görsch IC, Druchkiv V, Katz T, Linke SJ, Richard G. Do outside temperature and sunlight duration influence the outcome of laser refractive surgery? Results from the Hamburg Weather Study. Clin Ophthalmol 2014; 8:1129-37. [PMID: 24966665 PMCID: PMC4063864 DOI: 10.2147/opth.s57717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To examine the impact of temperature and sunlight duration on refractive and visual outcome of laser-assisted in situ keratomileusis (LASIK) in myopic eyes. SETTING University Medical Center Hamburg-Eppendorf, Germany, and Care Vision Refractive Centers, Germany. DESIGN Retrospective, cross-sectional data analysis. METHODS This study comprised 1,052 eyes of 1,052 consecutive myopic patients (419 males, 633 females; mean age at surgery 35.0±9.0 years) with a mean preoperative refractive spherical equivalent (SE) of -3.88±1.85 diopters (D). Two subgroups were defined, comprising patients undergoing surgery during either meteorological winter or summer. Manifest refraction, uncorrected, and corrected distant visual acuity (UDVA and CDVA) were assessed pre- and postoperatively. We applied robust regression analysis with efficiency index (EI), safety index (SI), and postoperative SE (in D) as dependent variables. RESULTS At the 1-month (33.0±5.0 days) follow-up, the mean postoperative SE was -0.18±0.44 D. Bivariate comparisons showed that statistically significant better EI was related to days with lower temperature. We obtained a significant difference for SI which suggested that low temperature had a positive influence on SI. No change by more than one line on LogMAR scale was obtained. CONCLUSION Although being statistically significant, there was no clinically relevant difference in the outcome of LASIK, which demonstrates its highly standardized quality. Prospective, longitudinal studies are warranted to address meteorotropic reactions through evaluating defined meteorological parameters.
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Affiliation(s)
- Ines Neuhaus-Richard
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Germany
| | - Andreas Frings
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Germany
| | | | - Vasyl Druchkiv
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Germany
| | - Toam Katz
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Germany ; Care Vision Refractive Centers, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stephan Johannes Linke
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Germany ; Care Vision Refractive Centers, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gisbert Richard
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Germany
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Huelle JO, Katz T, Druchkiv V, Pahlitzsch M, Steinberg J, Richard G, Linke SJ. First clinicial results on the feasibility, quality and reproducibility of aberrometry-based intraoperative refraction during cataract surgery. Br J Ophthalmol 2014; 98:1484-91. [PMID: 24879809 DOI: 10.1136/bjophthalmol-2013-304786] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To provide the first clinical data in determining the feasibility, quality and precision of intraoperative wavefront aberrometry (IWA)-based refraction in patients with cataract. DESIGN IWA refraction was recorded at 7 defined measurement points during standardised cataract surgery in 74 eyes of 74 consecutive patients (mean age 69±11.3 years). Precision and measurement quality was evaluated by the 'limits of agreement' approach, regression analysis, correlation analysis, Analysis of variance (ANOVA) and ORs for predicting measurement failure. Wavefront map (WFM) quality was objectivised and compared with the Pentacam Nuclear Staging analysis. RESULTS Out of 814 IWA measurement attempts, 462 WFMs could be obtained. The most successful readings (n=63) were achieved in aphakia with viscoelastic. The highest (50.63%, SD 20.23) and lowest (29.19%, SD 13.94) quality of WFMs across all measurement points were found after clear corneal incision and in pseudophakia with viscoelastic, respectively. High consistency across repeated measures were found for mean spherical equivalent (SE) differences in aphakia with -0.01D and pseudophakia with -0.01D, but ranges were high (limits of agreement +0.69 D and -0.72 D; +1.53 D and -1.54 D, respectively). With increasing WFM quality, higher precision in measurements was observed. CONCLUSIONS This is the first report addressing quality and reproducibility of WA in a large sample. IWA refraction in aphakia, for instance, appears to be reliable once stable and pressurised anterior chamber conditions are achieved. More efforts are required to improve the precision and quality of measurements before IWA can be used to guide the surgical refractive plan in cataract surgery.
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Affiliation(s)
- Jan O Huelle
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany South West Peninsula Postgraduate Medical Education, School of Ophthalmology, Plymouth, UK
| | - Toam Katz
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany Care Vision, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Vasyl Druchkiv
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Milena Pahlitzsch
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Johannes Steinberg
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Gisbert Richard
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Stephan J Linke
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany Care Vision, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
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Neuhaus-Richard I, Frings A, Ament F, Görsch IC, Druchkiv V, Katz T, Linke SJ, Richard G. Do air pressure and wind speed influence the outcome of myopic laser refractive surgery? Results from the Hamburg Weather Study. Int Ophthalmol 2014; 34:1249-58. [PMID: 24562594 DOI: 10.1007/s10792-014-9923-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 02/11/2014] [Indexed: 11/30/2022]
Abstract
Laser in situ keratomileusis (LASIK) is one of the dominant procedures for the surgical correction of refractive errors. Meteorotropic reaction has been described regarding the field of ophthalmology. This study was thus initiated to assess the impact of air pressure and wind speed on the refractive and visual outcome of LASIK in myopic eyes. Our study comprised 1,052 eyes of 1,052 consecutive myopic patients (419 males, 633 females; mean age at surgery 35.0 ± 9.0 years) with mean preoperative refractive spherical equivalent (SE) of -3.88 ± 1.85 diopters (D). Two subgroups were defined, which had undergone surgery either during meteorological winter or summer. Manifest refraction, uncorrected and corrected visual acuity were assessed pre- and post-operatively. We applied robust regression analysis with efficiency index (EI), safety index, and postoperative SE (D) as dependent variables. At the 1-month (33.0 ± 5.0 days) follow-up, the mean postoperative SE was -0.18 ± 0.44 D. Bivariate comparisons showed that statistically significant better EI was related to days with low to moderate air-pressure. This was confirmed by robust regression analysis. Moderate to high wind speed was related to more appropriate postoperative SE. No change by more than one line on logMar scale was obtained. Although being statistically significant, there is no clinically relevant difference in outcome of LASIK, which demonstrates its highly standardized quality. Prospective, longitudinal studies are warranted to address meteorotropic reactions through evaluating individual risk profiles.
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Affiliation(s)
- Ines Neuhaus-Richard
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Katz T, Frings A, Linke SJ, Richard G, Druchkiv V, Steinberg J. Laser in situ keratomileusis for astigmatism ≤ 0.75 diopter combined with low myopia: a retrospective data analysis. BMC Ophthalmol 2014; 14:1. [PMID: 24393469 PMCID: PMC3890523 DOI: 10.1186/1471-2415-14-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 01/02/2014] [Indexed: 11/16/2022] Open
Abstract
Background This study examined the refractive and visual outcome of wavefront-optimized laser in situ keratomileusis (LASIK) in eyes with low myopia and compound myopic astigmatism ≤ 0.75 diopter (D). Methods 153 eyes from 153 consecutive myopic patients (74 male, 79 female; mean age at surgery 40.4 ± 10.4 years) who had a preoperative refractive cylinder ≤ 0.75 D and a manifest sphere between -0.25 D and -2.75 D, and who had completed 4-month follow-up. Three subgroups defined by the magnitude of preoperative manifest refractive cylinder (0.25, 0.50, and 0.75 D) were formed. Manifest refraction, uncorrected and corrected visual acuity were assessed pre- and postoperatively. The astigmatic changes achieved were determined using the Alpins vector analysis. Results After 4 months (120.0 ± 27.6 days) of follow-up, a mean uncorrected distant visual acuity of 0.07 ± 0.11 logMAR and a mean manifest refraction spherical equivalent of -0.06 ± 0.56 D were found. There was no statistically significant difference in efficacy and safety between the preoperative cylinder groups. Astigmatic overcorrection for preoperative cylinder of ≤ 0.50 D was suggested by the correction index, the magnitude of error, the index of success, and the flattening index. Conclusions Low myopic eyes with a preoperative cylinder of ≤ 0.50 D were significantly overcorrected with regard to cylinder correction when combined with low myopic LASIK. Accordingly, we are cautious in recommending full astigmatic correction for eyes with low myopia and manifest cylinder of ≤ 0.50 D.
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Affiliation(s)
| | - Andreas Frings
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany.
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Katz T, Wasiak J, Cleland H, Padiglione A. Incidence of non-candidal fungal infections in severe burn injury: an Australian perspective. Burns 2013; 40:881-6. [PMID: 24380706 DOI: 10.1016/j.burns.2013.11.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 11/25/2013] [Accepted: 11/30/2013] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Infection remains the primary cause of morbidity and mortality in the burns patient population. While candidal infection in burns patients is well described, there is dearth of information regarding non-candidal fungal infections in this setting. METHOD All adult burns patients who developed non-candidal fungal infections over a period of 10 years (between January 2001 and June 2011) were included. Retrospective data analyzed included patient demographics, organisms cultured, antibiotic susceptibility patterns, treatment, length of stay and overall mortality. RESULTS The incidence of non-candidal fungal infections at our centre over the time period studied was 0.04%. A total of 12 patients had a fungus other than Candida isolated. Of these 12 patients, seven were thought to have clinically significant fungal infections and were treated with targeted anti-fungal therapy. Between them, seven species of fungus were isolated: Aspergillus fumigatus (n=7), Scedosporium prolificans (n=2), Fusarium solani (n=2), Mucor spp. (n=2), Absydia corymbifera (n=1), Penicillium (n=1) and Alternaria spp. (n=1). Of those definitively treated, two died, although fungal infection was not believed to be a contributing factor to these deaths. CONCLUSION We demonstrate a low incidence and attributable mortality of non-candidal fungal infections in the setting of early antifungal therapy and extensive surgical debridement at our state-wide Burns Service.
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Affiliation(s)
- T Katz
- Victorian Adult Burns Service, The Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia.
| | - J Wasiak
- Victorian Adult Burns Service and School of Public Health and Preventive Medicine, Monash University, The Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia.
| | - H Cleland
- Victorian Adult Burns Service and Department of Surgery, Monash University, The Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia
| | - A Padiglione
- Department of Infectious Diseases, The Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia
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Frings A, Katz T, Steinberg J, Druchkiv V, Richard G, Linke SJ. Ocular residual astigmatism: effects of demographic and ocular parameters in myopic laser in situ keratomileusis. J Cataract Refract Surg 2013; 40:232-8. [PMID: 24333012 DOI: 10.1016/j.jcrs.2013.11.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 10/31/2013] [Accepted: 11/08/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE To analyze the influence of demographic and ocular factors on ocular residual astigmatism (ORA) in myopic laser in situ keratomileusis (LASIK). SETTING University Medical Center Hamburg-Eppendorf, Hamburg, Germany. DESIGN Retrospective cross-sectional data analysis. METHODS Eyes of consecutive myopic patients scheduled for LASIK were studied to evaluate the influence on preexisting ORA of age, sex, ocular dominance, subjective cylinder and topographic astigmatism, subjective sphere, and mesopic pupil size. The ORA was determined using Alpins vector analysis. Two subgroups, defined by the ratio of ORA to preoperative refractive cylinder (R), were formed: ORA:R ≥ 1.0 and ORA:R <1.0). RESULTS The study comprised 2991 eyes (2991 patients). The mean ORA was 0.75 diopter (D) ± 0.39 (SD) (range 0.00 to 2.00 D); 1372 (46%) eyes had ORA of 1.00 D or more. Ordinary least square estimations and odds ratios showed that subjective sphere, male sex, and dominant eye were negative predictors of the degree of preoperative ORA, while increasing age and larger mesopic pupils did not indicate ORA orientation. With-the-rule astigmatism meridian was more likely in eyes with low ORA, while oblique and against-the-rule meridians were related to high ORA. CONCLUSIONS The preoperative assessment of refractive surgery candidates should consider the interaction between topographic, refractive, and ORA because corneal refractive surgery is more successful in eyes in which the cylinder mainly originates from the anterior cornea. The current data can help identify patients at high risk for having a significant difference between subjective cylinder and topographic astigmatism. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Andreas Frings
- From the Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Toam Katz
- From the Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Steinberg
- From the Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Vasyl Druchkiv
- From the Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gisbert Richard
- From the Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stephan J Linke
- From the Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Katz T, Wagenfeld L, Galambos P, Darrelmann BG, Richard G, Linke SJ. LASIK versus photorefractive keratectomy for high myopic (> 3 diopter) astigmatism. J Refract Surg 2013; 29:824-31. [PMID: 24202704 DOI: 10.3928/1081597x-20131029-03] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 08/05/2013] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the efficacy, safety, predictability, and vector analysis indices of LASIK and photorefractive keratectomy (PRK) for correction of high cylinder of greater than 3 diopters (D) in myopic eyes. METHODS The efficacy, safety, and predictability of LASIK or PRK performed in 114 consecutive randomly selected myopic eyes with an astigmatism of greater than 3 D were retrospectively analyzed at the 2- to 6-month follow-up visits. Vector analysis of the cylindrical correction was compared between the treatment groups. RESULTS A total of 57 eyes receiving PRK and 57 eyes receiving LASIK of 114 refractive surgery candidates were enrolled in the study. No statistically significant difference in efficacy [efficacy index = 0.76 (±0.32) for PRK vs 0.74 (±0.19) for LASIK (P = .82)], safety [safety index = 1.10 (±0.26) for PRK vs 1.01 (±0.17) for LASIK (P = .121)], or predictability [achieved astigmatism < 1 D in 39% of PRK- and 54% of LASIK-treated eyes, and < 2 D in 88% of PRK- and 89% of LASIK-treated eyes (P = .218)] was demonstrated. Using Alpins vector analysis, the surgically induced astigmatism and difference vector were not significantly different between the surgery methods, whereas the correction index showed a slight and significant advantage of LASIK over PRK (1.25 for PRK and 1.06 for LASIK, P < .001). CONCLUSIONS LASIK and PRK are comparably safe, effective, and predictable procedures for excimer laser correction of high astigmatism of greater than 3 D in myopic eyes. Predictability of the correction of the cylindrical component is lower than that of the spherical equivalent.
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